Since the outbreak, the World Health Organization has indicated that nine countries namely, South Africa, Mozambique, Tanzania, Ethiopia, Mauritius, Comoros, Seychelles and La Reunion are at high risk of plague importation, on account of trade and travel between Madagascar and these countries. If untreated, it has a fatality rate close to 100 percent and can be fatal within 24 hours of being contracted.

The WHO reported stated: "Historically, the plague was responsible for widespread pandemics with high mortality".

Since the outbreak began in August, almost 1,200 cases of the deadly disease have been reported in the country, according to an October 23 report from the United Nations' humanitarian affairs office and the Malagasy government.

South Africa is one of the countries which have already put measures in place to prevent an outbreak, according to the report.

How is it transmitted?

Plague is caused by a bacterium known as Yersinia Pestis usually affecting human beings and other animals including domestic animals such as cats and dogs.

Bubonic plague is the most common form of plague and is caused by the bite of an infected flea. Domestic cats can also carry the plague and scratches and bites from the infected felines pose a risk factor. Any person with pneumonic plague may transmit the disease via droplets to other humans.

Symptoms can be very flu-like and include a fever, chills, weakness and vomiting, amongst even more serious symptoms depending on the type of plague. The lymph node then becomes inflamed, tense and painful, and is called a 'bubo.' At advanced stages of the infection the inflamed lymph nodes can turn into suppurating open sores. That said, "the risk of regional spread is moderate", and the risk that plague will spread throughout Madagascar is "considered very high".

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